Can SSRI withdrawal (Citalopram 10mg) symptoms appear after even 2 months from stopping?
After a death in the family I went a bit loopy for a while, I was having constant panic attacks and intrusive thoughts about my own mortality.
I took Citalopram 10mg for 2 years, I stopped it 5 weeks ago after a quick ish taper (every other day for a few weeks, then every 3 days for a few weeks, then pretty quick).
Initially I felt a bit irritable, but otherwise great, I was feeling motivated and energised, and these intrusive and obsessional thoughts, as the doc put them, were no where to be seen.
Now 5-6 weeks later they are returning, and frankly I am scared. I'm also getting consistent headaches, like I feel very de-hydrated, even though I'm drinking a lot.
Citalopram has a half-life in your system of about 36 hours and is fully excreted within about 5 days of stopping. There's a process of downregulation as your serotonin transmitters and receptors adjust to the change, but that should happen completely within a matter of weeks. If what you're experiencing is withdrawal, we'd expect the symptoms to start within days of stopping your medication and to gradually improve.
A lot of what people call "withdrawal symptoms" are really just a recurrence of the illness that the SSRIs were treating. If you stop taking your blood pressure medication and your blood pressure goes up, we don't call it withdrawal.
I've been taking SSRIs for the best part of a decade. I don't think that I necessarily need them, I could probably stop taking them without relapsing into depression, but for me it just isn't a risk worth taking. I'm happy to stay on SSRIs indefinitely purely to reduce the risk of a recurrence of my illness - taking one pill a day to reduce my risk of a life-threatening illness is a complete no-brainer as far as I'm concerned. A lot of people (including a lot of doctors) are uncomfortable with that idea, but there's good evidence to show that long-term use of SSRIs is safe and effective.
I'd like to be able to say "if you don't want to go back on medication, ask your GP about psychotherapy", but you're probably not going to be able to access therapy through the NHS. If you can afford to go private then it's absolutely worth trying, but if I were you I'd go back on the citalopram just as a precaution against things getting worse.
>>5895 The only problem I have with going back on is the weight gain. I put on around 2 stone whilst on them and it's magically gone whilst I'm off then. This sounds inconsequential when compared to mental health, but for me it had a bit impact on my wellbeing, and I've been proud to lose this weight.
You might want to try sertraline, fluoxetine or paroxetine. They all work about as well as citalopram, but with different side-effect profiles. Fluoxetine and paroxetine tend to cause weight loss rather than weight gain.
>>5897 OP here, I was on Sertraline before Citalopram and it had the same weight gain issue. I honestly couldn't really tell the difference between the two drugs. I think Citalopram was slightly better. They both gave me equally as shit issues with my libido/sensitivity and orgasm intensity however.
I'll have a look into those other two, cheers both.
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No. 5903Anonymous 22nd September 2021 Wednesday 2:01 am5903Completely pleasureless orgasm post SSRI usage
Oh and I think stopping Citalopram has given me something called 'PSSD'.
My orgasms are now entirely pleasureless, like I'm taking a piss, and my libido is gone. Apparently this is a thing that people suffer with quite commonly. It's only been 5 ish weeks for me but needless to say I'm a bit fucking worried. Some people report this lasting decades/permanently.
>>5903 I spent most of my teenage years on Sertraline and never developed a libido. I don't know if that's due to the medication, because I'm still depressed or if I'm just asexual but it would probably be worrying if I knew what I was missing out on.
My dad quit Olanzapine 4 months ago and he still feels like shit. He has no appetite, no energy, and can't sleep. His nervous system may be permanently damage.
Do not ever fuck around with your brain chemistry.
Olanzapine is an antipsychotic used to treat schizophrenia and bipolar disorder. It's a nasty drug used to treat very nasty illnesses. Your old man has my full sympathy, but (with the exception of tardive dyskinesia) there's no evidence to suggest that antipsychotics can cause permanent damage. Unless his doctor is actively trying to get struck off, your dad would have been very seriously ill before they even considered prescribing olanzapine.
I've been referred to a psych doctor for possible depression with a side of ADD. You're scaring the bejeebus out of me, but my sex drive is already absent and the odd "orgasm" is like peeing as mentioned so how much worse can it get.
>>5903 Like I needed another reason to use the mental health services. I swore off ever going to one again for my mild depression, and never took the medications.
>>5908 Depression will do that to your libido, so will antidepressants unfortunately. I didn't notice anything on citalopram, at all in any way, didn't help or hinder. But venlafaxine was a big drought. And then coming off it felt like you were dazed when moving for a few weeks, like when you've got a bad cold and your vision feels like a tenth of a second behind where your eyes are pointing.
Talk to the doctor, if you trust them then you trust them. They have a lot of information and at the very least you can research their opinion. There are a lot of options, you'll be reet.
>>5910 I generally trust doctors, but I'm also /A/ so if the diagnosis should be ritalin, adderall or similar I think I might struggle to dose appropriately. I will still go ahead if I find a private place that I can afford (on the NHS the wait list is quite long). No idea what to expect, though. Do they inject my brain, is it talk therapy but better, blood tests and conclusions, getting sectioned if they decide I'm a danger? It seems quite intimidating.
I have an issue with my Citalopram, it completely fucks my sex life in every way possible. But does, generally, work for my depression. Who do I speak with to get sound advice on all these anti depressant drugs? My GP is shit. Can I just get a referral for a psychiatrist and ask for advice? I don't mind paying. These are powerful drugs and I can't keep messing around with them with stop-starting. I just want someone to give a shit.
If you choose to go private, you can just directly make an appointment with a psychiatrist. Expect to pay about £250 for an initial consultation and £150 for follow-up appointments. Unless you're prescribed something truly bizarre that the NHS won't touch, you can get your repeat prescriptions via your GP.
The brain is unfathomably complicated, antidepressants are effective but crude, so finding the right fit inevitably involves some amount of trial-and-error.
The most obvious option is escitalopram. Citalopram is an equal mixture of molecules that are mirror images of each other. The right-handed molecule doesn't appear to have any useful effects in treating depression, so escitalopram is just the left-handed molecule. This means you can take half the dose and get the same effect, possibly with reduced side-effects. Escitalopram used to be stupidly expensive, but it's now a cheap generic although not all GPs are aware of that fact.
If you can still get it up and spunk but you've lost your sex drive, try supplementing citalopram with bupropion. This is technically licensed as a smoking cessation treatment, but it's an effective antidepressant and it doesn't have any sexual side-effects. You may be able to reduce your dose of citalopram or switch over entirely to bupropion.
Most GPs (and a lot of psychiatrists) don't know it, but it's entirely safe to abruptly switch between equivalent doses of different SSRIs. Tapering off from one drug and stopping entirely before starting on a low dose of another drug is totally unnecessary unless you're switching between different classes of antidepressant. The reasonable switches from citalopram would be fluoxetine, paroxetine and sertraline - they're all quite similar to citalopram in mechanism and effect, but you might have reduced sexual side-effects depending on how you metabolise the different drugs.
>>5919 Thanks a lot. I'm surprised you can just see a psych without a referral, even if willing to throw money at it.
>>5919 My problem is a lack of sex drive and pleasureless orgasms. ED is not a problem. I also gain a fuck ton of weight on SSRIs, I become lazy, I can't sleep well. So far I've tried Sertraline and Citalopram.
>bupropion
I've read about this one. The yanks seem to hand it out like candy but I assumed it would be difficult to get in the UK. Honestly with all the horror stories around AD medications I'm wary to try something that isn't an SSRI (because I at least know the side effects of these). I'm close to calling up a private psych clinic I've found nearby, but what do I really say? Won't they think I'm taking the piss if I start mentioning other drugs myself or talking about how shit sex is? I just feel really trapped and lost with it all. A shitty phonecall with my doctor doesn't help and they treat me like a nuisance.
>Won't they think I'm taking the piss if I start mentioning other drugs myself or talking about how shit sex is?
Not at all. Your symptoms are a common side-effect of SSRIs and a psychiatrist will be perfectly familiar with them. The receptionist making the appointment won't necessarily ask about the reason for your appointment, but if they do ask and you don't want to go into details you can just say something like "I'm having side-effects from my antidepressants".
Bupropion is widely prescribed in this country as a stop-smoking treatment. GPs often aren't aware that it's useful as an antidepressant, but any competent psychiatrist should at least consider it as an option and you can get it prescribed on the NHS.
There are other options available privately, including a couple of clinics in the south east offering ketamine treatment.
If you're in or around the north west, MAC clinical trials regularly do studies on novel depression treatments - they'll pay you to take DMT or psilocybin in their clinic.
>>5920 I think you could try being very insistent with the GP, because GPs typically don't have the best understanding of less common psych drugs. It wasn't until I saw a proper psychiatrist under a community mental health team that stuff like lithium and buproprion came into play. But if it's just a case of wanting to switch to a different SSRI (I found fluoxetine less damaging to my sex life), the GP should be able to do a fairly rapid switch I should have thought.
Agomelatine, vortioxetine, any of the MAOIs. Mirtazapine and mianserin are tetracyclics with primary affinity for the H1 and alpha adrenergic receptors.
Other possible options include lithium, the atypical antipsychotics or t3/t4 for hypothyroidism. Ketamine is available privately in a couple of UK clinics, as is TMS. ECT is an option if your symptoms are sufficiently severe.
>>5924 Fuck, the first one sounded ideal. No weight gain, no side effects, just as reliable as other ADs. Then I read that it's on some sort of red list and GPs won't prescribe it.
Agomelatine is licensed in the UK, listed in the drug tariff and not controlled, so GPs can prescribe it if they think it's appropriate. Some Clinical Commissioning Groups recommend against prescribing it on cost grounds - it's more expensive than SSRIs or mirtazapine and you need regular liver function tests. Other CCGs recommend that it should only be prescribed by specialists. There's a bit of a postcode lottery, with some CCGs having hundreds of patients on agomelatine and some having none.
If you think it might be a good option and you have tried at least two other antidepressants, it's worth badgering your GP about it. The squeaky wheel gets the oil and all that.
Wish me luck. Paid for a psychiatrists assessment. I'm going to mention Buproprion. Although having done some googling, the seizure/heart attack talk has put me off a bit.
>>5928 I've been on it for nearly a year. I know it differs from person to person, but for me the only ill effects are sweating and tremors. I've been on probably 15 psychiatric medications, and it (and lithium) are the most effective drugs I've been on.
>>5929 Oh interesting. It's been a struggle to find any Brit on it at all. How did you manage to get a prescription? The psych I spoke to briefly said it would be difficult to get.
>>5930 I've been in the mental health system for a decade, so I've run pretty much the whole gamut of GP to talking therapies to community mental health team to specialist depression team. The CMHT put me on lithium, after a couple of years of various SSRIs, and then the specialist depression team put me on the buproprion because they were well versed in the less conventional depression treatments. It took about 8 years to get the treatment that worked for me, but I knew nothing at the beginning so maybe that could have been sped up had I been knowledgeable about potential treatments. My recommendation would be to try get referred to a CMHT, as they know their onions better than a GP, and are more likely to prescribe stuff beyond SSRIs.
>>5931 Well thanks for your input and I'm glad to hear it's working for you. If you don't mind a more personal question, how has this drug impacted your sex life? SSRis seem to mess that area of my life up big time. What I've done is booked a consultation with a psychiatrist via psychiatry-uk.com. I can't stand waiting. The GP told me I was set to be waiting years otherwise.
>>5932 SSRIs were a double edged sword with regards to sex life. It took literally hours to cum. The ladies appreciated the stamina, but if I wanted to wank it might take 4 hours to reach climax. My current cocktail (fluoxetine, olanzapine, buproprion, lithium) has my sex life back to relatively normal. I know there's variation between people, but for me I haven't got the sexual numbness I had with drugs like sertraline/citalopram, and I can easily get it up which I couldn't on the other SSRIs.
Well, it's been another 6 months and he's still wrecked. Can't eat or sleep, has no energy and has pain all over his body. He now weighs 6 stone and only leaves his bed to go to the bathroom. The doctor agrees it's probably nervous system damage caused by taking olanzapine for 8 years.
>>6091 That sounds awful, my heart goes out to you and your pa.
Not great to hear because olanzapine is essentially the one drug that consistently and effectively stabilises one of my loved ones. Before that, everything up to and including lithium either didn't make any positive impact or actively made things worse.
He's in hospital now and it's not looking good. He can't eat and says he wants to die because he's in constant pain especially in his chest. He's had scans and x-rays and they can't find anything physically wrong. They might try epilepsy drugs as they can be used to treat pain from nerve damage.
5mg is a very low dose, below what we'd normally consider therapeutically effective. 10mg is still a relatively low dose, but it should be much more effective without a significant increase in side effects. You could go up to 20mg and still be within the normal dose range.
We used to think that escitalopram was just a swizz by drug companies to sell citalopram at higher prices, but it turns out that it is slightly more effective.
